Suicide is not a political football

By Charles Huang 黃隆正

Speaking at a meeting in central Taiwan a few days ago, President Ma Ying-jeou (馬英九) noted that the suicide rate had fallen and that suicide was no longer one of the top 10 causes of death in Taiwan. Ma said that the number of suicides between January and September last year was 700 fewer than during the same period in 2010, and that he was astonished by the figures.

He opted to interpret the falling number of suicides as showing that his Chinese Nationalist Party (KMT) administration had delivered security and peace of mind to the public, while criticizing the former Democratic Progressive Party (DPP) administration for having presided over a relatively high rate of suicides. Ma’s comments stirred up a war of words between the rival pan-blue and pan-green political camps.

Frankly speaking, we in the medical profession were taken aback by what Ma said, and were left shaking our heads in dismay, because we who serve on the front line in hospitals have not noticed any discernible reduction in the number of attempted suicides we deal with. Further evidence comes from the Suicide Prevention Center, which reports that the incidence of suicide attempts continues to grow.

Of course, attempted suicide is not the same thing as death by suicide. They have different implications and are influenced by different factors. The attempted suicide cases mentioned above refer to people who were sent to hospital emergency rooms that are required to report such cases.

Such people are suffering so profoundly that, finding no other solution to their problems, they see suicide as their only means of escape. However, people who try to kill themselves do not always die. If high-risk cases are identified in good time and active measures are taken to treat such people’s problems (psychological or otherwise), there is a good chance of reducing the number who attempt suicide again and possibly succeed in killing themselves.

The fall in Taiwan’s suicide rate may have something to do with the setting up of a suicide prevention program in 2006. This scheme, which included the establishment of a Suicide Prevention Center, has had a definite effect, but it should be pointed out that it was initiated and implemented by the DPP administration of then-president Chen Shui-bian (陳水扁).

Another thing that has had some effect is that Taiwan’s media have in recent times heeded the National Communications Commission’s demand that they should exercise restraint in reporting suicide cases.

There are other factors that might influence the suicide rate. One thing that most people are probably unaware of is that the way causes of death are classified can also have an effect on the figures.

Causes of death are broadly divided into natural and unnatural causes. Natural death cases are judged by doctors, whereas unnatural deaths are determined by prosecutors based on autopsies. Where unnatural deaths are found not to be a result of homicide, the cause of death can be further classified as suicide, accident or undetermined. The official figures for the number of suicides therefore depends on how unnatural deaths are classified by prosecutors.

Research suggests that there may be considerable variation between prosecutors as to the proportion of deaths they classify as being caused by suicide. A paper published some time ago in an international journal by a research team including Taiwanese psychiatrist Chang Shu-sen (張書森) said that many suicides in Taiwan might be hidden among the figures published for accidental and undetermined deaths, and that as a result the suicide rate could be underestimated by more than 30 percent.